摘要腹腔镜直肠癌根治术中，外科医师通常选择保留左结肠动脉以增加吻合口血供。保留左结肠动脉时，由于肠系膜下动脉分型较多，左结肠动脉与肠系膜下静脉走行复杂，术前对上述脉管相互关系认识不充分，可能造成术中各种意外出血；术中如仅清扫左结肠动脉起始部位的淋巴结，并不能达到规范化的第253组淋巴结清扫，影响患者的术后生存率。中间联合头侧入路进行保留左结肠动脉的直肠癌根治术，通过术前CT血管成像技术判断肠系膜下动脉分型，实现左结肠动脉精准化保留，通过准确划定第253组淋巴结区域，实现第253组淋巴结规范化清扫，可高质量地完成腹腔镜直肠癌根治术。

abstractsIn order to increase the blood supply of anastomosis, surgeons choose to preserve the left colon artery (LCA) during the laparoscopic radical resection of rectal cancer. However, surgeons are always ailed by hemorrhage and incompletely dissection of No. 253 lymph nodes. One reason is the shortage of understanding the relationship between inferior mesenteric artery (IMA), LCA, and inferior mesenteric vein before surgery. Another reason is that surgeon always remove the lymph nodes around LCA, while don′t normatively resect No. 253 lymph nodes, which affect the overall survival rate. Therefore, the "medial-to-lateral approach" for laparoscopic preservation with LCA radical resection in rectal cancer was suggested in this article. The CT technique could be used to analyze the IMA classification, which contribuated to the standard conservation of LCA. Laparoscopic radical resection of rectal cancer could be completed of high quality, through accurate definition and exactly dissection of the No. 235 lymph nodes.